Forced medication OK’d for Tehama jail inmates in psychosis

RED BLUFF — The Tehama County Jail will have the authority to force inmates, whom a judge has declared unable to stand trial due to their mental state, to take psychiatric medications.

That comes after the county's Board of Supervisors voted 5-0 to designate it a mental health treatment facility during its Tuesday meeting, in which supervisors also heard about changes California is making to its foster care system.

Tehama Sheriff Dave Hencratt's proposal applies only to anti-psychosis medication, he said. The state is responsible for treating felons while the county handles the treatment of those in custody for misdemeanors, typically by sending them to a state psychiatric hospital.

Under state law, only certain mental health treatment facilities, such as those state psychiatric hospitals, can force people, whom a judge has declared incompetent, to take psychiatric medications. A county jail can qualify for that designation if the sheriff, public health and board of supervisors agree to it.

Under state law, ruling them unfit for trial under the law effectively grants the power to the jail's medical staff — as long as it has that treatment facility designation, said Arthur Wylene, county counsel. It also stalls their case until they improve.

In a letter to the supervisors, Health Services Agency Executive Director Valerie Lucero said the involuntary medication rule can also apply to those who have been found unfit, then improved and, upon their return to the jail, refuse medicine again.

Medical jail staff would be responsible for evaluating and dispensing the medication, Hencratt said.

Employees at the jail would not be able to force anyone else to take medication, Hencratt said.

The jail previously did not force anyone to take any medication, Hencratt said. But it has had 34 inmates declared unfit and in need of psychiatric treatment before cases proceed since January 2015. Seventeen of them currently are in custody, 14 of whom are awaiting access to one of the state psychiatric hospitals, which have long wait lists.

Hencratt said his office has had this option for some time. But a rising number of inmates with serious mental illnesses has prompted him to ask for this ability, he said.

"When we have the ability to force medications on people, a lot of times they take medication voluntarily," he said.

The idea is to improve their medical condition as they wait for access to the hospital, Hencratt said.

Officials with the sheriff's office, the Tehama County Health Services Agency and the County Counsel's Office will draw up the policy.

Supervisors also heard a report on major, state-driven changes coming down the pike for the county's adoption system.

Tehama County Probation Chief Richard Muench, along with public health and social service directors, cautioned the board that it has more questions than answers.

"This is going to be one of those adventures," Muench said.

That's because the law bears some similarities — and some differences — with the realignment law, he said. The two big differences, he said, are at the state level — the new foster system appears to be a much more one-size-fits-all approach. AB 109 at least allowed counties to experiment with various programs at the local level instead, he said.

"The intent of the law is good. The problem is getting control from the state," Muench said.

But the other difference garnered almost all of the supervisors' attention. While AB 109 provided some funds to the counties to cope with the changes, it remains unclear how much, if any, cash the county will get to implement changes.

Supervisor Steve Chamblin asked whether the schools will be involved in the discussion and help pay for it. Supervisor Candy Carlson asked similar questions about First 5 Tehama, which focuses on young children.

Officials said both agencies are involved in the discussions, though not as much as the county's agencies.

Among the changes they outlined:

- Conducting an initial assessment of the child and their needs, similar to how probation handles new cases, using a standardized statewide system.

- Bringing in a mental health counselor right away for the child.

- Standardizing the review and licensing process for foster homes, relatives, family friends, guardians and adoptive families across the state.

- Shifting away from group homes for anyone other than the most troubled children and even then only in the short term.